Abstract
We report a case of acute coronary syndrome secondary to intermittent extrinsic compression
of the left anterior descending coronary artery by inward-pointing rib exostosis in
an 18-year-old woman during forceful repeated expiration in labour. The diagnosis
was achieved using multimodality noninvasive cardiac imaging. In particular, we demonstrated
the novel role of expiratory-phase cardiac computed tomography in confirming the anatomical
relationship of the bony exostosis to the left anterior descending coronary artery.
The case reminds us the heart and mediastinum move dynamically, relative to the bony
thorax, throughout the respiratory cycle, and that changes in cardiac physiology in
pregnancy may become pathological.
Résumé
Nous présentons un cas de syndrome coronarien aigu secondaire à une compression extrinsèque
intermittente de l’artère coronaire descendante antérieure par l’exostose d’une côte
pointant vers l’intérieur chez une femme de 18 ans lors d’expirations énergiques répétées
durant l’accouchement. Le diagnostic a été posé au moyen de l’imagerie cardiaque multimodale
non invasive. Notamment, nous avons démontré le nouveau rôle de la tomodensitométrie
cardiaque en phase expiratoire en confirmant la relation anatomique de l’exostose
osseuse vers l’artère coronaire descendante antérieure. Le cas nous rappelle que le
cœur et le médiastin se déplacent de manière dynamique par rapport au gril costal
tout au long du cycle respiratoire, et que les modifications de la physiologie cardiaque
au cours la grossesse pourraient devenir pathologiques.
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References
- Pericardial haemorrhage caused by costal exostosis.Ann Thorac Surg. 2002; 74: 2171-2172
- Juxtacardiac costal osteochondroma presenting as recurrent haemothorax.Eur J Cardiothorac Surg. 2001; 20: 208-210
Article info
Publication history
Published online: May 16, 2015
Accepted:
May 8,
2015
Received:
May 5,
2015
Footnotes
See page 1303.e11 for disclosure information.
Identification
Copyright
© 2015 Canadian Cardiovascular Society. Published by Elsevier Inc. All rights reserved.
